Open AccessA Double Whammy: Severe Aortic Stenosis and Cocaine Overwhelm the Mitral Valve
Author(s) -
Rohit Maini,
Jonathan Lim,
Jing Liu,
Itamar Birnbaum,
Fadi G. Mirza,
Nasser Lakkis,
Ihab Hamzeh
Publication year - 2018
Publication title -
methodist debakey cardiovascular journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.552
H-Index - 23
eISSN - 1947-6094
pISSN - 1947-6108
DOI - 10.14797/mdcj-14-1-63
Subject(s) - medicine , cardiology , cardiogenic shock , mitral regurgitation , stenosis , mitral valve , chordae tendineae , regurgitation (circulation) , myocardial infarction
A 50-year-old man presented with acute onset dyspnea following cocaine use. He had severe aortic stenosis (AS), mild mitral regurgitation (MR) due to mitral valve prolapse, and no coronary artery disease on recent coronary angiography. He was in acute heart failure with signs of impending cardiogenic shock. Urgent bedside echocardiography revealed hyperdynamic left ventricular systolic function with acute severe MR from a ruptured chordae tendineae. The acute cocaine-induced spike of his already elevated left ventricular systolic pressure from severe AS likely precipitated chordal rupture of his vulnerable mitral valve. This patient underwent emergent mitral and aortic valve replacements. Although cocaine use has been associated with a myriad of cardiovascular complications, acute MR due to chordal rupture has not, to our knowledge, been previously reported in this setting. Prompt diagnosis with echocardiography and surgical intervention are of paramount importance in the management of acute MR.